Provider Demographics
NPI:1063589307
Name:JOHN PAINTER, DO
Entity type:Organization
Organization Name:JOHN PAINTER, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOROWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-655-3854
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-0319
Mailing Address - Country:US
Mailing Address - Phone:207-655-3854
Mailing Address - Fax:207-655-2557
Practice Address - Street 1:49 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:ME
Practice Address - Zip Code:04071
Practice Address - Country:US
Practice Address - Phone:207-655-3854
Practice Address - Fax:207-655-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432540200Medicaid
MEDG8243Medicare PIN
MEME2323Medicare PIN